Senators To Trump: Don't Pull The Rug Out From Under States Fighting Opioid Crisis

Feb 08, 2017 05:14AM
● By Theresa Gilman

Elizabeth Warren

(Editor's Note: the following information was submitted by the office of
U.S. Senator Elizabeth Warren, D-Mass.)

WASHINGTON,
D.C.- U.S. Senator
Elizabeth Warren (D-Mass.) joined Sens. Sherrod Brown (D-Ohio), Tammy Baldwin
(D-Wis.), Jeanne Shaheen (D-N.H.) and 19 additional Senate colleagues in warning
President Donald Trump that repealing the Affordable Care Act (ACA) with no replacement
would pull the rug out from under local communities working to combat the opioid
epidemic and could endanger millions of Americans just as they are getting treatment.

Repeal threatens
to cut $5.5 billion from states battling opioid addiction. A recent report from
Harvard Medical School and New York University details the devastating impact the
repeal would have on those struggling with addiction. Nationwide, nearly 1.3 million
Americans currently receiving treatment for substance abuse or mental health disorders
would be kicked off of their coverage under repeal. And states would lose $5.5 billion
in federal dollars each year that go toward treating these Americans through the
Medicaid expansion or the marketplaces.

"The
consequences of repealing the Affordable Care Act are dire for all Americans, but
they are especially calamitous for Americans living with a mental illness, a substance
use disorder, or both," said the Senators in the letter sent today. "Repealing
this law will cut billions of dollars in funding, kick tens of millions of Americans
off of their health insurance, and saddle providers with hundreds of millions of
dollars more in uncompensated care."

In December
2016, President Obama signed into law the bipartisan 21st Century Cures Act - legislation
that will provide $1 billion in federal grant funding over the next two years to
states like Ohio, Wisconsin, and New Hampshire that have been hardest-hit by the
opioid epidemic. But now, Congress is working to repeal the health law and pull
addiction services - and funding for treatment - out from under millions of Americans.
In the letter, the Senators note that at the same time states are competing for
the grants made available through Cures, ACA repeal stands to take away $5.5 billion
in just one year from addiction and mental health treatment services.

February 3, 2017
The Honorable Donald J. Trump
President of the United States of America
The White House
1600 Pennsylvania Ave, NW
Washington, DC 20500

Dear President
Trump:

We write
with serious concern that your work advancing efforts to repeal the Affordable Care
Act (ACA) with no clear plan for replacement will substantially worsen the opioid
epidemic, endangering the lives of millions of Americans with opioid use disorders.
Last year, Congress took important steps to address this national public health
crisis, enacting not one, but two bipartisan laws to address the opioid epidemic
and reform the way our health system treats mental health and substance use disorders.
However, repealing the ACA with no clear plan for a replacement, you risk both undermining
all of that progress and setting our communities fighting the opioid epidemic farther
back with the stroke of a pen.

The Comprehensive
Addiction and Recovery Act (P.L.114-198) authorized programs to improve access to
substance use disorder prevention, treatment, and recovery services. It promoted
the use of best practices when prescribing opioid pain-killers, strengthening state
prescription drug monitoring programs, and expanding access to the life-saving drug
naloxone. Importantly, the legislation also allowed nurse practitioners and physician
assistants to begin prescribing the drug buprenorphine to treat addiction.

The 21st
Century Cures Act (P.L.114-255) also included critical mental health and substance
use disorder reforms, establishing an Assistant Secretary for Mental Health and
Substance Use, strengthening enforcement of mental health parity laws, promoting
the integration of physical and mental health care, and promoting an expanded mental
health workforce.

Most importantly,
the 21st Century Cures Act dedicated $1 billion in new funding over two years to
assist states in combatting the opioid epidemic. Already, states are actively working
on applying for this new grant funding, which will be essential to helping states
provide prevention, treatment, and recovery services to patients, especially those
who have trouble affording them and those living in rural areas and on tribal lands.

These bipartisan
advances and accomplishments will be fundamentally undermined by repeal of the Affordable
Care Act, which critically strengthened the health care foundation on which these
recent measures are built. What is more, your ACA repeal agenda stands in direct
conflict with your public commitment to end the opioid epidemic in America. In a recent article, two former Assistant Secretaries
for Planning and Evaluation noted that, "repealing the mental health and substance
use disorder coverage provisions of the ACA would withdraw at least $5.5 billion
annually from the treatment of low income people with mental and substance use disorders."
A funding cut that is more than ten times greater than the funding increase included
in the 21st Century Cures Act.

To make
matters worse, repealing the ACA would mean that more than 1.2 million people with
serious mental illness and 2.2 million people with substance use disorders will
lose some or all of their coverage. In the states with the highest opioid overdose
death rates, the uninsured rate would triple. Repeal would also hurt providers by
increasing uncompensated care. Further, since passage of the ACA, the number of
hospitalizations for substance use or mental illness in which the patient was uninsured
dropped from 22 percent to 14 percent. We would be likely to see these numbers skyrocket
after ripping coverage away from millions of Americans, forcing them back into the
emergency room when they have nowhere else to go.

Repealing
the ACA will undo critical consumer protections for tens of millions of Americans
and rob more than 9 million families of the tax assistance provided under the law
to make their coverage affordable. Furthermore, it will roll back the same mental
health and substance use disorder parity protections that were strengthened under
the 21st Century Cures Act, and eliminate the mandatory coverage of treatment for
these conditions as an essential health benefit. In addition, repealing the ACA
will make it even more difficult to diagnose mental illness and substance use disorders
by removing the requirement that preventive services like depression and addiction
screenings are provided to patients for free at the point of service.

The ACA's
investments in substance use disorders, while critical to addressing the immediate
needs of the opioid epidemic, are essential to continue fighting all types of addiction.
In addition to hurting millions of Americans struggling with addiction, cutting
funding for substance use disorder prevention, treatment, and recovery services
could significantly increase costs to our health care system and taxpayers in the
long-run. According to the National Institute on Drug Abuse, illicit drugs such
as cocaine and methamphetamines already cost our health care system $11 billion
annually.

The consequences
of repealing the Affordable Care Act are dire for all Americans, but they are especially
calamitous for Americans living with a mental illness, a substance use disorder,
or both. Repealing this law will cut billions of dollars in funding, kick tens of
millions of Americans off of their health insurance, and saddle providers with hundreds
of millions of dollars more in uncompensated care. We strongly urge you to uphold
your pledge to end the opioid epidemic in America by working to strengthen substance
abuse treatment protections and taking no further action to repeal the Affordable
Care Act without guaranteeing that such actions and policies will not harm Americans
with mental illnesses or substance use disorders.